Do you ask your patients about guns?

[GetMeOuttaThisMess]

I've been following a thread at GlockTalk.com regarding a pediatrician asking a parent as to whether or not they have firearms in the home.  Wow, the responses that have been generated are eye-opening.  The question has previously been part of, and may still be part of, the available AAFP annual questionnaire/exam form and I have commented to patients in years past when doing annual exams that the rationale behind the question was safety for in-home children (even though it can also be used to assess possible risks in those with MH issues, not that other options wouldn't be available).  I am just amazed at the extent some folks will go to defend their choice and fear that black helicoptors will swarm over their home if they answer truthfully.  I guess that a definitive hard-nosed stance on the question already answers the question.  Yes, I am an owner/CHL holder (obvious I presume since I've been following the thread) and personally wouldn't care if someone asked such a question as long as they were willing to explain the rationale.  As I recall, the next question on the questionnaire was how many sexual partners in the past 12 mos./lifetime.  That one also got a lot of stare backs.  As a HCP, I believe that these are relevant questions to ask but reality also says that patients don't trust our ability to keep records protected.

[Boatswain2PA]

The same lack of trust is why we, apparently, will have a crazy socialist or an megalomaniac businessman as our next President.

 

I don't trust our government either, and wouldn't answer either of those questions.

[Guest Paula]

I don't ask about guns.  I assume most of my patients have them in their homes.  I rarely see kids anymore so haven't done any education or made any comments about gun safety with patients. 

 

Will ask if a person is suicidal.

 

Ask patients the questions at an annual exam:  Have you ever done anything in the past or currently that puts you at risk for an STI, Hepatitis C or HIV?

 

If they answer yes, I talk about screening for all 3  and offer them the tests.  

 

(The election will be interesting, that's for sure). 

[rev ronin]

On guns, we should probably be asking "if not, why not?"  Because that is more likely to lead to answers that underlie serious potential risks ("No, my baby daddy is a convicted felon", "No, everyone else in my family died via suicide so I avoid guns") that may or may not be related to firearms themselves.

 

The well has been poisoned on this topic by one-sided studies trying to treat guns as a public health problem, without acknowledgement of the crimes, both property and violent, prevented every year by the lawful threat or use of deadly force.  Fact is, guns can be used for both good and bad, and unless one is willing to demonstrate credibility on the issue, (e.g., Eddie the Eagle gun safety material in patient info racks) then asking the patient a loaded question (pun intended) is more likely to damage the patient-provider relationship than it is to do anyone any good.

[UpRegulated]

I've been following a thread at GlockTalk.com regarding a pediatrician asking a parent as to whether or not they have firearms in the home.  Wow, the responses that have been generated are eye-opening.  The question has previously been part of, and may still be part of, the available AAFP annual questionnaire/exam form and I have commented to patients in years past when doing annual exams that the rationale behind the question was safety for in-home children (even though it can also be used to assess possible risks in those with MH issues, not that other options wouldn't be available).  I am just amazed at the extent some folks will go to defend their choice and fear that black helicoptors will swarm over their home if they answer truthfully.  I guess that a definitive hard-nosed stance on the question already answers the question.  Yes, I am an owner/CHL holder (obvious I presume since I've been following the thread) and personally wouldn't care if someone asked such a question as long as they were willing to explain the rationale.  As I recall, the next question on the questionnaire was how many sexual partners in the past 12 mos./lifetime.  That one also got a lot of stare backs.  As a HCP, I believe that these are relevant questions to ask but reality also says that patients don't trust our ability to keep records protected.

 

The issue is, what concrete, evidence-based data show that asking such questions makes any difference whatsoever in improving health outcomes?  Until that is shown, it is just another intrusion into and imposition on, the personal rights, freedoms, and beliefs of individuals by those with a particular political agenda. 

 

I would also add, hesitancy to answer these questions is less about anyones concern about the ability to keep records protected and more about it being no one's business. 

[winterallsummer]

Although it is probably an almost infintismally low yield question (in terms of helping - where I live I know many would answer yes) I have read the few odd news stories of some poor child who was playing with a gun and fatally shot themselves or another young sibling. Could this have been avoided if the parents PCP or child's pediatrician brought this up in a routine exam and educated the parent on safety and storage? Hard to say. Doubt any good evidence will ever be collected. The "con" of asking is losing trust in suspecting parents who feel you are "against them" rather than advocating for them or their children. The other situation is in suicidal patients who own guns. Obviously need to be told to get rid of them or other actions taken. Is the "NNT" to prevent a suicide or accidental death outweighing the "NNH" to mistrust caused in parents? Hard to say and it must weigh heavily on how much rapport you have and how you go about asking. Again I seriously doubt good data can or would ever be collected on this matter (eg hard evidence although perhaps some soft study does exist?) so this will probably always be provider preference.

 

Anyways I work in acute care so not really my issue but just my two cents on the matter.

[UpRegulated]

Although it is probably an almost infintismally low yield question (in terms of helping - where I live I know many would answer yes) I have read the few odd news stories of some poor child who was playing with a gun and fatally shot themselves or another young sibling.

 

Yeah, those are anecdotes though.  What about the stories of kids getting into their parents prescription drugs?  Or their parent's ETOH?  Or Jeffrey Dahmer who states getting hooked on the porn in his parent's house started him down the road of becoming Jeffrey Dahmer?  Who is cool with telling your kid's pediatrician what prescription drugs you are on, or what if any ETOH you have in your house, or what your porn habits are?  All of these things are arguably "health concerns" regarding kids. 

 

I would bet a small fortune that parent's ETOH and prescription drugs kill far more kids than guns in the house. But spreading unfounded fear about guns is far more politically correct and expedient.  And anyone who thinks whatever health organization is non-political or unbiased is naive.

[Boatswain2PA]

Although it is probably an almost infintismally low yield question (in terms of helping - where I live I know many would answer yes) I have read the few odd news stories of some poor child who was playing with a gun and fatally shot themselves or another young sibling. Could this have been avoided if the parents PCP or child's pediatrician brought this up in a routine exam and educated the parent on safety and storage? Hard to say. Doubt any good evidence will ever be collected. The "con" of asking is losing trust in suspecting parents who feel you are "against them" rather than advocating for them or their children. The other situation is in suicidal patients who own guns. Obviously need to be told to get rid of them or other actions taken. Is the "NNT" to prevent a suicide or accidental death outweighing the "NNH" to mistrust caused in parents? Hard to say and it must weigh heavily on how much rapport you have and how you go about asking. Again I seriously doubt good data can or would ever be collected on this matter (eg hard evidence although perhaps some soft study does exist?) so this will probably always be provider preference.

 

Anyways I work in acute care so not really my issue but just my two cents on the matter.

The infintismally low numbers of children playing with (a relatively responsible) parent's gun and shoots someone is a miniscule fraction compared to the crimes prevented by law-abiding homeowners.  

 

And in emergent/acute care or family practice...suicidal patients don't go home, they get admitted. 

[PACdan]

I just don't understand what behavior asking directly changes. "Do have guns at home? Oh you do. Well, keep them locked up and out of the reach of children." Couldn't the same effect be achieved by making a statement that doesn't require either an affirmation or denial on the parents part? "IF you have guns, prescription drugs, caustic chemicals, or katanas at home, keep them secured and out of your child's reach, mmkay?"

 

It feels like telling them not to let their kid play with a toaster in the bathtub, but okay. However, what does the provider knowing actually change?

[sk732]

Our medical questionnaire in the military used to ask "Have you been in any fights in the last 'x' months/year?"  A suitable quesion if you think about it - self defence vs anger management vs PTSD vs personality D/O vs just plain dickhead, etc.  Was always fun to watch the reaction when that was brought up...and the responses to the button pushing if you followed the cookie crumbs.  Fact is, I live in a country where it is a privilege, much like driving is, to own and use firearms, not a right entrenched in our constitution.  I would often bring up the issue by discussing hobbies or what plans were for hunting season, etc.  People knowing I am ex-military will sit and chat with me about firearms, the kinds they like, have and use then.  If I knew they had youngens or oldies in the house, I'd casually ask about guns safes and such - all mandatory requirements here for storage.  I had a boss many years ago whose son was killed by 12 yo who casually pointed a rifle out his window and shot at the random kid on the street, killing him.   Parent that owned the shooter just had the weapon casually hanging out, with ammo in the magazine. 

 

I think the line of questioning is legit...how you go about it is up to you.  We ask a lot more taboo questions than those about gun safety on any given day IMHO.

 

$0.02 Cdn

 

SK

[CAAdmission]

I am a fairly avid firearms enthusiast. If asked, I would be happy to respond that there are some small police departments that might envy my collection.

 

I think the best exchange between a patient and a healthcare provider I saw on a gun forum went something like this:

 

Provider: Do you have any firearms in your home?

 

Patient: Does your wife enjoy anal intercourse?

 

Provider: I can't see how that is any of your business.

 

Patient: Exactly.

[CAAdmission]

Although it is probably an almost infintismally low yield question (in terms of helping - where I live I know many would answer yes) I have read the few odd news stories of some poor child who was playing with a gun and fatally shot themselves or another young sibling.

 

The funny thing is, there are a decent percentage of children who get access to a firearm because their parent works in law enforcement. These people certainly receive a lot of training and should know better.

[winterallsummer]

I never said I am for or against asking patients about guns. Just adding this would be the perceived benefit of it. If I DID work in a clinic I doubt I would ask. But this thread alone shows how uncomfortable a topic it is, even among professionals. As I said, I don't know if it would ultimately help or hurt overall. Probably more prudent would be a non health care campaign about gun safety for this issue.

 

When I rotated through peds, one of the pediatricians would routinely ask parents do you keep your Rx and ETOH locked up when kids were in the 2-3 age range. Never saw a parent get offended.

[PAMEDIC]

I have no problem asking about pools, car seats, seatbelts, Rx, or firearms.

 

Me doing so is out of concern for my patients and their families and it provides an opportunity to educate on safety issues involved in all of those things.

 

It isn't some sort of conspiracy to infringe on anybody's rights. It isn't reported to shadowy men in black who are writing it all down as part of their plan to invade peoples' homes to confiscate their guns.

[Boatswain2PA]

PAMedic - of course you are not "part of some conspiracy."

 

However look at what is happening with VA mental health and proposed regulation to use their reports to deprive some veterans of their gun rights.

 

I don't see how any reasonable person couldn't come to the conclusion that the current administration wants to reduce gun ownership as much as possible.  I won't help in that effort.

[BruceBanner]

I think it's overstepping our bounds. It's too easy to inflect your own personal leanings on the issue, and while yes it is a safety concern with children, I just don't think this falls under something a medical professional should be advising on. 

 

I probably wouldn't answer truthfully if a provider asked me that. 1) I don't feel it's his or her business, and 2) I have no idea what sort of righteous beliefs this person has about personal firearms.

 

It's a redundant lecture to give anyway. It's like telling someone to buckle up. Yeah I know that, thanks for your unsolicited input on my personal property. 

[medic25]

The issue is, what concrete, evidence-based data show that asking such questions makes any difference whatsoever in improving health outcomes?  Until that is shown, it is just another intrusion into and imposition on, the personal rights, freedoms, and beliefs of individuals by those with a particular political agenda. 

 

I would also add, hesitancy to answer these questions is less about anyones concern about the ability to keep records protected and more about it being no one's business. 

 

It is very hard to produce evidence-based data when the CDC and NIH are blocked from receiving any funding to research firearms as a public health issue.  The gun lobby has consistently blocked all efforts to generate any evidence-based research.

[PAMEDIC]

I think it's overstepping our bounds. It's too easy to inflect your own personal leanings on the issue, and while yes it is a safety concern with children, I just don't think this falls under something a medical professional should be advising on. 

 

I probably wouldn't answer truthfully if a provider asked me that. 1) I don't feel it's his or her business, and 2) I have no idea what sort of righteous beliefs this person has about personal firearms.

 

It's a redundant lecture to give anyway. It's like telling someone to buckle up. Yeah I know that, thanks for your unsolicited input on my personal property. 

 

You don't have to ask these questions to everybody, but there are good reasons to ask about firearms.

 

I am in the Army and we have a horrific suicide problem. I have worked with or known 6 soldiers who have committed suicide in the last 6 years. We screen for depression, suicidal ideation, plans, and means. If a soldier is having suicidal thoughts, then we try to find out if they have the easy means of acting on these thoughts. So yeah... we ask if they have any firearms at home. If you have a good relationship with your patients, they will often be quite forthcoming. We can talk to them and get Behavioral Health involved.

 

I can't help but think that all the agitprop out there fueling conspiratorial notions that medical providers are asking these questions in order to confiscate their patients' guns is doing us a disservice and ultimately harming my relationship with my patients and their willingness to be open and honest with me.

[Reality Check 2]

I ask all pediatric well exam patients about pools, firearms, bike helmets, booster seats and the like.

 

A soon to be kindergartner should know what Mom and Dad's real names are and the street they live on.

 

I ask them if they ride a bike and what do they wear when they ride the bike.

 

I ask if pools have safety fences. I remind parents (of all ages) that a child can drown in 2 inches of water.

 

We talk about car seats and boosters and the like.

 

I ask if there are any firearms in the house. NOT ONE SINGLE PATIENT has ever gotten mad at me in all these years. I ask about trigger locks and gun safes.

 

I ask the child directly what they would do if they found a gun in someone's house - I ask right in front of a the parents. The overwhelming majority of kids say they wouldn't touch it and they would go get an adult.

 

These are kids in an open carry gun loving state with tons of hunters. Most kids hunt by 7 and own a .22 by age 10. The majority have been taught to ALWAYS ASSUME a gun is loaded and not touch a gun if they come across it.

 

Most kids tell me that if a friend took out a gun at their house when they were visiting that they would be uncomfortable and worried about a bad accident. One said he would just leave.

 

So, Kids AREN'T STUPID and we need to talk to THEM like people and not just adults. They get it most of the time.

 

I could care less about conspiracy theories or government oversight when I am talking to an 8 year old.

 

I DO NOT believe automatic and high round weapons should be in the hands of civilians. I WOULD defend myself against human violence if necessary.

 

So, asking straightforward matter of fact questions in an effort to give people some food for thought is necessary.

 

Also, remember that a PA got sued about 15 yrs ago by a smoker who wouldn't quit. He cited that the PA NEVER told him ALL the potential consequences of smoking therefore he didn't REALLY know he should quit.

 

So, again, until Americans decide to have half a brain and an ounce of common sense -- we get to play parent and guardian and warn people about basic DUMB A&& things they should already know.

 

Ok, off the soapbox - I have 3 rooms filling up.....

[cop to pa]

I think it's overstepping our bounds. It's too easy to inflect your own personal leanings on the issue,

In regards to this, our pediatrician asks about firearms. I answered truthfully the first time. The look on her face made me think I had passed gas in her office (I hadn't). Now, it has always been safely stored and my son doesn't even know it exists. But, I've lied to her every other time she's asked.

 

Not because of the question, but because of her affect at the response.

[Boatswain2PA]

 

 

So, again, until Americans decide to have half a brain and an ounce of common sense -- we get to play parent and guardian and warn people about basic DUMB A&& things they should already know.

 

 

I doubt that's going to happen, especially when our doctor's take on the role of nanny instead of the role of physician/healer.

 

Do you ask them if they look both ways before they cross the street?  Do they have safety locks on their windows?  What kind of fertalizer does dad use on the lawn?  Do they have frogs or turtles as pets?  (cause salmonella can be bad).  Do they have railings on their porch?  Do they have GFCI's near their kitchen sink and in their bathroom?

 

I see wayyyyy more ATV injuries (in adults AND kids) than I see firearm injuries, why don't we ask every child if mom and dad have an ATV?

 

BTW - I'm fine with you asking your patients WHATEVER you want to ask them.  I am NOT fine with the government even TRYING to require us to ask questions.  

[FfIghter23]

our pediatrician asked if we had guns in the house and if they were stored "appropriately."

 

I answered and then asked why she asked-- curious if there was a recent rise in pediatric gun deaths in the area (I knew there wasn't). She said it was built into her Medent template and just got used to asking it. I just nodded but was a little put off. She basically was just checking boxes and didn't seem to care about the topic one way or the other.

[Acebecker]

I do not see peds well-child often and if I am concerned about the family then would be inclined to ask about firearms, smoke detectors, safety belts, car seats, bike helmets, etc.  Here's the thing, though...  I know how to safely store firearms, so me asking them is a legitimate question. 

 

Many docs, PAs, NPs who ask about safe storage of firearms have no clue how to store firearms.  So it's the blind leading the blind in that case.  As Ffighter23 said, they have  no idea why they're even asking.  "Oh, you do have firearms in the home...  Well that's nice.  Next question...." 

 

Our FP doc asked my wife the gun question so she turned to my son and asked him what a gun is.  He said, without hesitation, "No touch!"  And the FP doc (at that time) didn't even understand the concept of teaching 2 and 3 year olds about gun safety.  "Wait, you already have that covered?!?" 

 

To think that it's a government conspiracy is a little ridiculous, too.  As mentioned above - there *are* some people who need to be asked, others who obviously have it down.  Now, checking a box that can be data mined does give me a little bit of a pause.  Tying reimbursement to whether or not we check that box gives me even more pause. 

[GetMeOuttaThisMess]

These varied responses are exactly why I posed the question. I'm not sure why but for some reason I'm surprised there aren't more on the "I do" or "I would" ask side of the fence.

[cbrsmurf]

Yes, I would ask.

 

Just like I would ask about safety belts, car seats, drug use or smoking in the house.  It can affect the child's health.

 

If you guys are so concerned about gov't conspiracies, just don't document it.